Marmot Indicators 2015 A preliminary summary with graphs

Marmot Indicators 2015 A preliminary summary with graphs Marmot Indicators 2015 Fair Society, Healthy Lives, The Marmot Review was published in 2010 i. The review set out the key areas that needed to be improved to make a significant impact in reducing health inequalities. This release provides an update on progress to reduce inequalities in health against the Review s six key policy recommendations: A. Give every child the best start in life B. Enable all children, young people and adults to maximise their capabilities and have control over their lives C. Create fair employment and good work for all D. Ensure healthy standard of living for all E. Create and develop healthy and sustainable places and communities F. Strengthen the role and impact of ill health prevention The following year Sir Michael published data showing key indicators for monitoring inequalities and the social determinants of health for the 150 upper tier local authorities. Since then the Institute of Health Equity (HAVE AS LINK) has continued to monitor inequality trends. 1

Key messages 1. Health indicators Life expectancy and health expectancy 2011-3 Healthy life expectancy at birth declined very marginally between 2010-12 and 2011-13, from 63.4 to 63.3 for males and from 64.1 to 63.9 for females in England as a whole. At a regional level, the only significant decline was for females in the East of England, from 66.1 to 65.4. There was a gradient in healthy life expectancy of upper tier local authorities by level of area deprivation, which changed little over the two time periods. For example, in 2011-13 healthy life expectancy for males in Blackpool, the most deprived area based on the 2015 classification, was 54.9 while it was 71.4 in Wokingham (classified as the least deprived) a 16.5 year difference. For females the respective figures were 58.3 and 69.9 an 11.6 year difference. Male healthy life expectancy at local authority level, by index of multiple deprivation, 2010-12 and 2011-13 Female healthy life expectancy at local authority level, by index of multiple deprivation, 2010-12 and 2011-13 2

Life expectancy 2012-13 For England as a whole, life expectancy at birth increased very marginally between 2010-12 and 2011-13, from 79.2 to 79.4 for males and from 83.0 to 83.1 for females. At a regional level, the largest increases were for London for both sexes and for the North West for males. There was a gradient in the life expectancy of upper tier local authorities by level of area deprivation, which changed little over the time period. For example, life expectancy for males in Blackpool, the most deprived area based on the 2015 classification, was 74.3 while it was 81.7 in Wokingham, classified as the least deprived a 7.4 year difference. For females the respective figures were 80.1 and 84.7 a 4.6 year difference. Male life expectancy at local authority level, by index of multiple deprivation, 2010-12 and 2011-13 3

Female life expectancy at local authority level, by index of multiple deprivation, 2010-12 and 2011-13 Expected years in ill-health at birth increased between 2010-12 and 2011-13, from 15.8 to 16.1 for males and from 18.9 to 19.2 for females in England as a whole. This was the result of a very small increase in life expectancy (from 79.2 to 79.4 years for males and from 83.0 to 83.1 for females) and a very small decrease in healthy life years (from 63.4 to 63.3 years for males and from 64.1 to 63.9 for females). At a regional level, the largest increases were in the East Midlands for males and in the East of England for females. There was a gradient in expected years in ill-health of upper tier local authorities by level of area deprivation, which changed little over the time period. For example, years of expected ill-health was 19.4 for males in Blackpool, the most deprived area based on the 2015 classification, and 10.3 years in Wokingham, classified as the least deprived a 9.1 year difference. For females the respective figures were 21.8 and 14.8 a 7 year difference. 4

Expected years in ill-health for males, by index of multiple deprivation, 2010-12 and 2011-13 Expected years in ill-health for females, by index of multiple deprivation, 2010-12 and 2011-13 Local inequality in life expectancy at birth is measured using the gradient across small areas (grouped into deciles). Local inequalities tended to be greater for authorities with higher levels of area deprivation, but there was a greater degree of variability than for overall life expectancy of areas. For example, inequality in life expectancy for males in Blackpool, the most deprived area based on the 2015 classification, was 11.8 years compared to 4.8 years in Wokingham, classified as the least deprived a 7 year difference. For females the respective figures were 6.7 and 5.6 years a difference of only 1.1 years. The area with the largest level of inequality in life expectancy was Stockton on Tees (17.3 years for males and 11.4 years for females). For males, the level of inequality in life expectancy was least in Barking and Dagenham - 2.4 years and in Islington for females 0.6 years. 5

Slope index of inequality in male life expectancy within local authority areas, by index of multiple deprivation, 2010-12 and 2011-13 Slope index of inequality in female life expectancy within local authority areas, by index of multiple deprivation, 2010-12 and 2011-13 6

2011 Census based figures Healthy life expectancy 2009-13 National and regional inequalities in healthy life expectancy at birth in each local authority area is measured using the gradient across small areas within the authority. The median level of inequality across all local authorities in England was 16.7 years for males and 16.8 years for females. The median was highest in the North West (19.2 and 18.7 years, respectively) and least in the South West (12.0 and 10.9, respectively). Local inequality in healthy life expectancy Inequalities within local authorities tended to be greater for authorities with higher levels of area deprivation, but there was a greater degree of variability than for overall healthy life expectancy of areas. For example, inequality in healthy life expectancy for males in Blackpool, the most deprived area based on the 2015 classification, was 16.6 years while it was 7.1 years in Wokingham, classified as the least deprived a 9.5 year difference. For females the respective figures were 6.7 and 5.6 years a difference of only 1.1 years. The area with the largest level of inequality in healthy life expectancy was Kensington and Chelsea for males - 24.6 years - and Bradford for females - 22.1 years. For males, the level of inequality in healthy life expectancy was least in Newham 3.8 years and in Shropshire for females 2.8 years. Slope index of inequality in male healthy life expectancy within local authority areas, by index of multiple deprivation, 2009-2013 Slope index of inequality in female healthy life expectancy within local authority areas, by index of multiple deprivation, 2009-2013 7

Disability free life expectancy 2009-2013 National and regional inequalities in disability free life expectancy at birth in each local authority area is measured using the gradient across small areas within the authority. The median level of inequality across all local authorities in England was 14.5 years for males and 13.6 years for females. It was highest in the North West (17.0 and 15.7 years, respectively) and least in the East of England for males (10.7 years) and in the South West for females (9.1years). Local inequality in disability free life expectancy Inequalities within local authorities tended to be greater for authorities with higher levels of area deprivation, but there was a greater degree of variability than for the overall disability free life expectancy of areas. For example, inequality in disability free life expectancy for males in Blackpool, the most deprived area based on the 2015 classification, was 14.5 years while it was 5.9 years in Wokingham, classified as the least deprived a 9.6 year difference. For females the respective figures were 11.8 and 5.4 years a difference of 6.4 years. The area with the largest level of inequality in disability free life expectancy was Kensington and Chelsea for males 21.7 years - and the Wirral for females 17.6 years. The level of inequality in disability free life expectancy was least in Newham 3.5 years for males and 2.2 years for females. Male slope index of inequality in disability free life expectancy within local authority areas, by index of multiple deprivation, 2009-2013 8

Female slope index of inequality in disability free life expectancy within local authority areas, by index of multiple deprivation, 2009-2013 Life expectancy National and regional inequalities in life expectancy at birth in each local authority area is measured using the gradient across small areas within the authority. The median level of inequality across all local authorities in England was 7.9 years for males and 5.9 years for females. It was highest in the North West (9.8 and 7.5 years, respectively) and least in the South West (5.9 and 4.1 years, respectively). Local inequality in life expectancy Inequalities within local authorities tended to be greater for authorities with higher levels of area deprivation, but there was a greater degree of variability than for the overall life expectancy of areas. For example, inequality in life expectancy for males in Blackpool, the most deprived area based on the 2015 classification, was 9.1 years while it was 4.1 years in Wokingham, classified as the least deprived a 5 year difference. For females the respective figures were 7.5 and 5.0 years a difference of only 2.5 years. The area with the largest level of inequality in life expectancy was Stockton on Tees for males 12.6 years - and Middlesbrough for females 10 years. The level of inequality in life expectancy was least in Shropshire for males 2.5 years - and in Windsor and Maidenhead for females 0.3 years. 9

Male slope index of inequality in life expectancy within local authority areas, by index of multiple deprivation, 2009-2013 Female slope index of inequality in life expectancy within local authority areas, by index of multiple deprivation, 2009-2013 10

Comparisons between small areas in 1999-2003 and 2009-2013 Life expectancy and disability free life expectancy To make comparisons over the ten years between 1999-2003 and 2009-2013 it is necessary to look at figures for life expectancy and disability free life expectancy (as healthy life expectancy is not available on a comparable basis). The figure below compares life expectancy and disability free life expectancy in small areas (middle level super output areas) around the time of the 2001 and 2011 Censuses. Between these periods, there was a larger increase in life expectancy than in disability free life expectancy. For England as a whole, life expectancy rose from 75.9 to 79.1 years between the two periods for males and from 80.6 to 83.0 years for females, while disability free life expectancy rose from 61.7 to 64.1 years for males and from 64.1 to 65.0 years for females. Increases were seen at every level of deprivation of small areas. As a result, the number of years that people could expect to live with a disability increased at all levels of deprivation. Those in more deprived areas will spend longer with a disability than in less deprived areas. Male life expectancy and disability free life expectancy at birth in 1999-2003 and 2009-13 by neighbourhood deprivation 11

Female life expectancy and disability free life expectancy at birth in 1999-2003 and 2009-13 by neighbourhood deprivation A new tool is available on the ONS website that enables anyone in England, by typing their postcode, to find out the expected level of healthy years in the small area in which they live, as shown in these figures, and the inequality in healthy life expectancy that existed across their local authority in 2009-13. The tool can be found here. Expected years with a disability The gap in number of years with a disability between the fifth most deprived areas and the remainder decreased slightly over the ten years. However, across the remaining four fifths of areas, there was no change in inequality in years with a disability by level of deprivation. Among females, there was a much smaller increase in disability free life expectancy than in life expectancy. As a result the number of years with a disability increased considerably more for females than males at every level of deprivation. 12

Expected years of disability from birth for males in 1999-2003 and 2009-13 by neighbourhood deprivation Expected years of disability from birth for females in 1999-2003 and 2009-13 by neighbourhood deprivation 13

Well-being England and English regions The proportion of adults aged over 16 years reporting low levels of life satisfaction in England and all English regions fell between 2012/13 and 2013/14. Among adults aged over 16 years, approximately 4.8% of the English population rated their life satisfaction as very low in 2014/15 compared to 5.6% in 2013/14. The North West and East Midlands reported the greatest annual reduction in the proportion of the population reporting low levels of life satisfaction. 14

Local authorities At a local authority level, the percentage of people reporting low levels of life satisfaction increased with level of local deprivation. There was also large variation. In 2013/14, Wolverhampton had the largest proportion of its population reporting low life satisfaction (8.7%), while Bath and North East Somerset had the lowest at (2.8%). Local authority % of population reporting low life satisfaction Wolverhampton 8.7 Rochdale 8.6 Greenwich 8.6 Liverpool 8.5 Knowsley 8.2 Bath and North East Somerset 2.8 Hampshire 2.9 Buckinghamshire 2.9 Oxfordshire 3.2 Devon 3.2 In addition, in Barking and Dagenham and Lambeth the largest annual falls in the proportion of people reporting low life satisfaction were recorded (6 and 4.2 percentage points respectively), which means that their averages now respectively match and exceed the English average. The greatest rise was recorded in Wakefield (2 percentage points). In Dudley, the rise means that the area is now worse than the English average, whereas in 2013/14 it was better than the English average. 15

LA area Greatest fall in population reporting low life satisfaction % reporting low life satisfaction 2014/15 % reporting low life satisfaction 2013/14 % annual change in low life satisfaction Barking and Dagenham 4.8 10.8-6.0 Lambeth 4.6 8.7-4.2 Rochdale 8.6 12.7-4.1 Halton 5.3 8.9-3.6 Blackburn with Darwen 5.9 9.4-3.6 Greatest rise in population reporting low life satisfaction Wakefield 7.8 5.8 2.0 Dudley 6.3 4.6 1.7 Greenwich 8.6 7.0 1.6 Doncaster 7.6 6.0 1.6 Sunderland 7.9 6.6 1.3 NB: Bold figures indicate where % reporting low life satisfaction matched or exceeded the English average for that year 2. Giving every child the best start in life Children reaching a good level of development at age 5 ( readiness for school ) School readiness: In 2013/14, 60.4% of all children and 44.8% of pupils eligible for free school meals achieved a good level of development 1 at the end of reception, compared to 51.7% and 36.2% respectively the previous year. This significant improvement is good news and reflects improvements in the scores of all pupils and those eligible for free school meals. The percentage of FSM pupils achieving a good level of development remains consistently lower however than that for all pupils. 1 A good level of development at age 5 refers to children who achieved at least the expected level in the early learning goals of the Early Years Foundation Stage (EYFS) in the prime areas of learning (personal, social and emotional development; physical development; and communication and language) and the early learning goals in the specific areas of mathematics and literacy. 16

The proportion of all pupils and those eligible for free school meals achieving a good level of development at age 5 also increased in each English region between 2012/13 and 2013/14 2. 2 The Department for Education changed the way in which it measured young children s development in 2012. This led to a break in the time series as the results were not comparable between 2011/12 and 2012/13. 17

The proportion of FSM pupils achieving a good level of development each year was consistently lower than that for all pupils, both across years and regions. In 2013/14, 60.4% of all pupils in England achieved a good level of development, compared with only 44.8% of pupils eligible for free school meals. If the same proportion of pupils eligible for free school meals achieved a good level of development as the proportion of all pupils, there would have been 17,580 more children achieving a good level of development at age 5 3. Annual percentage change in the school readiness gap between all and FSM pupils, 2012/13 2013/14 3 Calculation: Number of eligible FSM pupils 2013/14 = 112,697 (source: file:///\\ad.ucl.ac.uk\home\rmjdjro\documents\sfr46_2014_national_la_tables.xls) multiplied by 60.4% (all pupil English average) minus 112,697 multiplied by 44.8% (FSM pupil English average). 18

The quick look summary table at the end of this pack shows the comparative gap between all pupils and those eligible for free school meals achieving a good level of development at age 5, both across years and regions. In England the gap increased from 15.5 percentage points in 2012/13 to 15.6 percentage points in 2013/14. At a regional level, the gap increased in two-thirds of regions. In 2013/14, London recorded the narrowest gap (9.9 percentage points), almost half that seen in the South West (18.9). In 2012/13, the school readiness gap ranged from 9.8% in London to 18.8% in the South West. The gap Local authority level There is substantial variation in results across the country - at a local authority level, the gap between all and FSM pupils in 2013/14 varied from a relatively narrow 4.2 percentage point gap in Hackney, where 64.9% of all pupils and 60.7% of those eligible for free school meals achieved 5+ GCSEs or equivalent, to a relatively large 29.5 percentage point gap in Bath and North East Somerset, where 62.5% of all pupils and only 33% of those eligible for free school meals achieved 5+ GCSEs or equivalent. These variations suggest that there is more that can, and should be done to reduce inarea inequalities. 19

The local authority areas with the highest and lowest proportions of school ready FSM pupils in 2013/14 Local authority area % of all pupils achieving a good level of development 2013/14 % of FSM pupils achieving a good level of development 2013/14 Organised by local authority areas with the highest proportion of pupils eligible for free school meals achieving a good level of development Lewisham 75.3 68.1 Greenwich 73.2 64.9 Bexley 72.9 61.9 Hackney 64.9 60.7 Newham 65.1 59.9 Organised by local authority areas with the lowest proportion of pupils eligible for free school meals achieving a good level of development Blackburn with Darwen 46.5 31.7 Wigan 55.4 32.2 Stockton-on-Tees 50.2 32.7 Bath and North East Somerset 62.5 33 Halton 45.6 33.3 The local authority areas that recorded the highest proportion of pupils eligible for free school meals achieving a good level of development in 2013/14 were all in London. In Lewisham and Greenwich over two-thirds of pupils eligible for free school meals achieved a good level of development at age 5 (68.1% and 64.9% respectively). Both areas also have relatively high proportions of good development for all pupils (75.3% and 73.2% respectively). Further investigation is required to understand what is driving this pattern. In some local authorities however only around one-third of pupils eligible for free school meals achieved a good level of development in 2013/14, although this was also accompanied by relatively low proportions of all pupils achieving a good level of development, apart from in one local authority area (Bath and North East Somerset). 20

The local authority areas with the widest and narrowest school readiness gap between all and FSM pupils in 2013/14 Local authority area % of all pupils achieving a good level of development 2013/14 (with % above or below English average for all pupils) % of FSM pupils achieving a good level of development 2013/14 (with % above or below English average for FSM pupils) Gap between all and FSM pupils achieving a good level of development Local authority areas with the widest gap between FSM and all pupils 2013/14 Bath and North East Somerset 62.5 (+2.1) 33 (-11.8) 29.5 West Berkshire 64.9 (+4.5) 36.1 (-8.7) 28.9 Richmond upon Thames 64.2 (+3.8) 36.1 (-8.7) 28.1 Windsor and Maidenhead 66.4 (+6) 39.7 (-5.1) 26.7 Herefordshire 59.9 (-0.5) 33.7 (-11.1) 26.2 Local authority areas with the narrowest gap between FSM and all pupils 2013/14 Hackney 64.9 (+4.5) 60.7 (+15.9) 4.2 Tower Hamlets 55 (-5.4) 50.7 (+5.9) 4.3 Newham 65.1 (+4.7) 59.9 (+15.1) 5.1 Waltham Forest 63 (+2.6) 57.6 (+12.8) 5.5 Westminster 57.9 (-2.5) 52.3 (+7.5) 5.7 The above table shows the local authority areas with the widest and narrowest recorded school readiness gaps between all pupils and those eligible for free school meals in 2013/14. The widest gap was in Bath and North East Somerset where nearly two-thirds (62.5%) of all pupils in Bath and North East Somerset achieved a good level of development in 2013/14, 2.1 percentage points higher than the English average, compared with only one in three (33%) pupils eligible for free school meals, which is 11.8 percentage points behind the English average. The 5 local authority areas with the narrowest gap were all in London, with relatively narrow gaps of between 4.2 and 5.7 percentage points. Hackney the 10 th most deprived area in England 4 - reported the smallest gap of 4 Based on IMD15 21

4.2 percentage points and is especially notable because 60.7% of pupils eligible for free school meals achieved school readiness, a sizeable 15.9 percentage points above the English average for FSM pupils, and all pupil achievement at age 5 is also 4.5 percentage points above the national average. Newham and Waltham Forest have similarly achieved a narrow gap between the proportion of all pupils and those eligible for free school meals achieving a good level of development, at the same time as having a high proportion (above the English average) of all and FSM pupils achieving a good level of development. Reducing inequalities in school readiness - England and English regions To reduce in-area inequalities, local authority areas need to aim for a higher proportion of both all pupils and pupils eligible for free school meals reaching a good level of development each year. But the proportion of FSM pupils achieving a good level of development needs to increase at a faster rate than the rate for all pupils. To recap, between 2012/13 and 2013/14 there was an 8.7% increase in the proportion of all pupils in England achieving a good level of development, versus an 8.6% increase for those eligible for free school meals. This means that inequalities in child development widened, but not significantly. The local authority areas that reported the greatest proportion increase and decrease in school readiness for FSM pupils 2012/13 2013/14 The table below lists the five local authority areas that reported the greatest increase or decrease in proportion of school readiness for those eligible for free school meals between 2012/13 and 2013/14. The largest decrease of 4.8 percentage points was recorded in West Berkshire. It also shows the areas that saw the greatest rise in the proportion of FSM pupils ready for school between 2012/13 and 2013/14, with Hounslow, Warrington and East Sussex all reporting a greater than 20% increase. 22

Local authority area School readiness - FSM pupils 2012/13 School readiness - FSM pupils 2013/14 Annual % point change Greatest annual rise in proportion of FSM pupils ready for school East Sussex 26.7 49.4 22.7 Warrington 17.8 38.4 20.6 Hounslow 29.2 49.1 20.0 Wirral 27.7 46.6 18.9 Fall in proportion of FSM pupils ready for school West Berkshire 40.9 36.1-4.8 Brent 52.4 50.7-1.7 Herefordshire 34.4 33.7-0.8 Blackburn with Darwen 31.9 31.7-0.2 Stoke-on-Trent 41.1 41.0-0.1 NB: Bold figures indicate where proportions of school readiness matched or exceeded the English average for that year The percentage of all and FSM pupils achieving a good level of development 2013/14 by area level of deprivation The figure below shows that in 2013/14, the gap between all and FSM pupils was greater in more advantaged areas, and tended to narrow with increasing area deprivation. This was because fewer FSM pupils achieved school readiness in more advantaged areas compared with more disadvantaged areas. At the same time, levels of development for all children were generally better in more advantaged areas compared with more disadvantaged areas. 80% 0% Most deprived Least deprived 23

GCSE Attainment (or equivalent): Between 2012/13 and 2013/14, the attainment of 5+ GCSEs or equivalent (including English and Maths), fell from 60.8% to 56.8% for all pupils, and from 38.1% to 33.7% for pupils eligible for free school meals. GCSE reforms however, which aimed to make GCSEs more challenging 5, had an impact on the 2013/14 GCSE and equivalent results. England and English regions - Proportions of all and FSM pupils achieving 5+ GCSEs, 2012/13 2013/14 The proportion of all pupils and those eligible for free school meals achieving 5+ GCSEs 6 decreased nationally and for each English region between 2012/13 and 2013/14 (see summary table at end of pack). This fall in GCSE attainment 7 comes after GCSE reforms, which aimed to make GCSEs more challenging. These changes have subsequently affected calculations for this indicator, which means that the latest findings from 2013/14 are not directly comparable with data from prior years. The summary table at the end of this pack shows the extent to which these reforms have impacted both the change in overall attainment and the gap in attainment between FSM and all pupils.. 5 Appendix 4 https://www.gov.uk/government/publications/2010-to-2015-government-policyschool-and-college-qualifications-and-curriculum/2010-to-2015-government-policy-school-andcollege-qualifications-and-curriculum 6 The achievement of 5 or more GCSEs or equivalent, grades A*-C including English and Mathematics 7 The achievement of 5 or more GCSEs or equivalent, grades A*-C including English and Mathematics 24

Percentage point In 2013/14, London recorded the narrowest gap (14.9 percentage points), less than half that seen in the South East (30.4). In 2012/13, the GCSE attainment gap ranged from 14.2% in London to 29.6% in the South East. The gap in GCSE attainment between all pupils and those eligible for free school meals was smallest in 2011/12. Further to the reforms, this attainment gap widened to 23.1 percentage points in 2013/14. Attainment gap between FSM and all pupils achieving 5 or more GCSEs (or equivalent) inc. Maths and Eng. 24.5 24.2 24 23.5 23.9 23.7 23 22.5 22.5 22.7 23.1 22 21.5 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 Year In 2013/14, 56.8% of all pupils in England achieved 5+ GCSEs, compared with only 33.7% of pupils eligble for free school meals. If the same percentage of pupils eligible for free school meals achieved 5+ GCSEs, as the proportion of all pupils, there would have been 18,520 more young people achieving 5+ GCSEs. Local authority area At a local authority level, there is substantial variation in the gap between all and FSM pupils. In 2013/14, Tower Hamlets reported a relatively narrow gap of 4.6 percentage points between the proportion of all pupils achieving 5+ GCSEs, at 59.8%, and the proportion of pupils eligible for free school meals achieving 5+ GCSEs, at 55.2%. This is compared to a 40.9 percentage point gap in York in 2013/14, where 62.3% of all pupils and only 21.4% of those eligible for free school meals achieved 5+ GCSEs or equivalent. These variations suggest that there is more that can, and should be done to reduce in-area inequalities. 25

Between 2012/13 and 2013/14, only Camden and Portsmouth managed to reduce in-area inequalities in higher GCSE attainment between all and FSM pupils, by which we mean that higher proportions of all pupils and those eligible for free school meals achieved 5+ GCSEs, but pupils eligible for free school meals improved at a faster rate than that for all pupils. Further detail is provided below: The local authority areas with the highest and lowest proportions of FSM pupils achieving 5+ GCSEs in 2013/14 Local authority area % of all pupils achieving 5+ GCSEs 2013/14 % of FSM pupils achieving 5+ GCSEs 2013/14 Organised by local authority areas with the highest proportion of pupils eligible for free school meals achieving 5+ GCSEs Westminster 68.1 62.6 Kensington and Chelsea 74.4 62.0 Tower Hamlets 59.8 55.2 Islington 59.9 54.6 Southwark 62.4 52.4 Organised by local authority areas with the lowest proportion of pupils eligible for free school meals achieving 5+ GCSEs Rutland 62.7 16.0 Barnsley 47.1 19.6 Knowsley 35.4 20.0 York 62.3 21.4 South Gloucestershire 54 22.1 The local authority areas that recorded the highest proportion of pupils eligible for free school meals achieving 5+ GCSEs in 2013/14 were all in London. In Westminster, and Kensington and Chelsea over 60% of pupils eligible for free school meals achieved 5+ GCSEs (62.6% and 62% respectively). In these areas, the percentage of FSM pupils achieving 5+ GCSEs exceeded the all pupil English average by 5.8 and 5.2 percentage points respectively, as well as the all pupil average for each English region. Further investigation is required to understand the drivers of this pattern. In some local authorities however less than a quarter of pupils eligible for free school meals achieved 5+ GCSEs in 2013/14, although this is also accompanied with relatively low proportions of all pupil higher GCSE attainment, apart from in Rutland and York, where the GCSE attainment of all pupils exceeded the English average. In Rutland and Barnsley, fewer than 1 in 5 pupils eligible for free school meals achieved 5+ GCSEs in 2013/14. 26

- The local authority areas with the widest and narrowest GCSE attainment gap between all and FSM pupils in 2013/14 Local authority area % of all pupils achieving 5+ GCSEs 2013/14 (with % above or below English average for all pupils) % of FSM pupils achieving 5+ GCSEs 2013/14 (with % above or below English average for FSM pupils) Gap between all and FSM pupils achieving 5+ GCSEs Local authority areas with the widest gap between FSM and all pupils 2013/14 Rutland 62.7 (+5.9) 16.0 (-17.7) 46.7 York 62.3 (+5.5) 21.4 (-12.3) 40.9 Buckinghamshire 69.2 (+12.4) 29.5 (-4.2) 39.7 Southend-on-Sea 62.2 (+5.4) 23.0 (-10.7) 39.2 Cheshire East 61.4 (+4.6) 25.0 (-8.7) 36.4 Local authority areas with the narrowest gap between FSM and all pupils 2013/14 Tower Hamlets 59.8 (+3) 55.2 (+21.5) 4.6 Islington 59.9 (+3.1) 54.6 (+20.9) 5.3 Westminster 68.1 (+11.3) 62.6 (+28.9) 5.6 Lambeth 57.0 (+0.2) 49.0 (+15.3) 8.0 Hackney 58.8 (+2) 50.6 (+16.9) 8.1 The above table shows wide variations in the attainment gap between all pupils and those pupils eligible for free school meals. The local authority areas with the widest and narrowest recorded gap between the proportion of all pupils and those eligible for free school meals achieving 5+ GCSEs in 2013/14. York reported the second widest gap of 40.9 percentage gaps, where 62.3% of all pupils achieved higher GCSEs, compared to just over one-fifth of pupils eligible for free school meals. 27

The 5 local authority areas with the narrowest gap were all in London, with relatively narrow gaps of between 4.6 and 8.1 percentage points. Tower Hamlets the 9 th most deprived area in England 8 - reported the smallest gap of 4.6 percentage points. Each of these areas achieved a narrow gap in GCSE attainment between all and FSM pupils at the same time as having a high proportion (above the English average) of all and FSM pupils achieving higher-level GCSEs. The below table also shows the local authority areas where FSM pupil GCSE attainment has decreased at a far greater rate compared with the rate for all pupils since the GCSE reforms. In Rutland and York, the percentage decrease in the proportions of FSM pupils achieving 5+ GCSEs was 18.3 and 18.8 respectively, compared with a respective percentage decrease of 4.5 and 5.1 for all pupils. Local authority area % of all pupils achieving 5+ GCSEs 2013/14 (with data from 2012/13) Percentage point increase 2012/13 to 2013/14 for all pupils % of FSM pupils achieving 5+ GCSEs 2013/14 (with data from 2012/13) Percentage point change 2012/13 to 2013/14 for FSM pupils Percentage point change difference (FSM pupils (minus) all pupils) Local authority areas where a greater proportion of all and FSM pupils achieved 5+ GCSEs, with FSM pupils improving at a greater rate compared with the rate for all pupils (further to GCSE reforms). Camden 60.5 (60.4) (+) 0.1 50.7 (43.7) 7.0% (+) 7 Portsmouth 50.8 (47.6) (+) 3.3% 31.3 (22.6) 8.7% (+) 5.5% where FSM pupil GCSE attainment has decreased at a far greater rate compared with the rate for all pupils since the GCSE reforms Rutland 62.7 (67.2) (-) 4.5 16 (34.3) (-) 18.3 (-) 13.8 York 62.3 (67.4) (-) 5.1 21.4 (40.2) (-) 18.8 (-) 13.7 Windsor and Maidenhead Kensington and Chelsea 62.3 (68.3) (-) 6 34.3 (48.4) (-) 14.1 (-) 8.1 74.9 (81.9) (-) 7.5 62 (76.7) (-) 14.7 (-) 7.2 East Riding of 57.2 (59.9) (-) 2.6 27.1 (36.4) (-) 9.3 (-) 6.7 Yorkshire NB: Bold figures indicate where proportions of higher GCSE attainment matched or exceeded the English average for that year The percentage of all and FSM pupils achieving 5+ GCSEs, 2013/14 by area level of deprivation The below Figure shows that in 2013/14, the gap between all and FSM pupils was greater in more advantaged areas, and tended to narrow with increasing area deprivation. This was because fewer FSM pupils achieved 5+ GCSEs in more advantaged areas compared with more disadvantaged areas. 8 Based on IMD15 28

At the same time, higher GCSE attainment for all children was generally better in more advantaged areas compared with more disadvantaged areas. 3. Young people not in education, employment or training People aged 19-24 who are not in employment, education or training (NEETs): Following the economic downturn in 2008, the percentage of young people aged 19-24 not in education, employment or training (NEET) in England increased year on year to 2011, from 15.7% to 18.5%. The figures however have since fallen year on year so that the percentage of NEETs in 2014 (15.9%, down from 17.1% last year) was just higher than reported in 2008 (15.7%). Following the recession, proportions of NEET in England increased up to 2011 and have fallen year on year so that proportions of NEET in 2014 was just higher than those reported in 2008. This trend is generally repeated across all English regions, although more variable rates were seen between 2008 and 2014 compared to the English average. 29

At the end of 2014, 15.9% of young people aged 19-24 in England were not in employment, education or training (NEET), a decrease of 1.2 percentage points from the previous year. Most regions in England also reported a fall in the proportion of young people NEET, although some English regions saw a greater reduction than others. The South West and the East Midlands reported the greatest fall in NEETS over the period 2013 2014 (4.2 and 4.1 percentage points, respectively). Conversely, the North East and the South East reported increased proportions of NEET from 2013 to 2014 (2.1 and 2.9% increase, respectively). Overall, the South West and London had relatively lower levels of young adults NEET in 2014 (12.9% and 13.5% respectively), compared to the North East in particular, where around 1 in 5 young adults were NEET. 30

4. Create fair employment and good work for all Unemployment Unemployment in England gradually increased from 2005 to 2011, and decreased year on year to 2014 with the latest rates (6.2% in 2014) approaching those seen in 2008 (5.8%). The 2014 figure represents a fall of 1.3 percentage points from a rate of 7.5% the previous year 31

The summary table at the back of this pack shows how unemployment levels fell across all English regions in 2014, although some areas saw greater reductions than others. The East Midlands and London reported the greatest annual fall in unemployment (a fall of 1.8 percentage points). At a regional level, unemployment levels were lowest in the South of the country (4.8% in the South East, 5% in the South West), while the North East reported the highest rate of unemployment at 8.5%. Local authority level At a local authority level, unemployment was highest in Middlesbrough (12.5%), and lowest in Hampshire (2.9%) in 2014 Local authority area Proportion of population 16+ without a job 2014 Areas with the highest proportion of population without a job Middlesbrough 12.5 Liverpool 12.0 Kingston upon Hull 11.7 Hartlepool 11.3 Wolverhampton 11.3 Areas with the lowest proportion of population without a job Hampshire 2.9 Rutland 3.1 Wokingham 3.2 West Berkshire 3.2 Warwickshire 3.3 Oxfordshire 3.3 The largest annual increase in unemployment rates (2013-2014) was reported in St Helens (1.9 percentage point increase), while the largest annual decrease was reported in Leicester (a decrease of 5 percentage points). 32

Local authority area Proportion of population 16+ without a job 2013 Proportion of population 16+ without a job 2014 Percentage annual change in unemployment 2013-2014 Areas with the largest proportion increase in unemployment St Helens 8.1 10.0 (+) 1.9 Poole 3.9 4.6 (+) 0.7 Somerset 4.4 5.1 (+) 0.7 Derbyshire 4.1 4.7 (+) 0.6 Cumbria 5.1 5.5 (+) 0.4 Areas with the largest proportion decrease in unemployment Leicester 13.7 8.7-5.0 Tower Hamlets 13.2 8.9-4.3 Salford 11.7 8.1-3.6 Birmingham 14.5 10.9-3.6 Sunderland 12.3 9.0-3.3 Lewisham 10.0 6.7-3.3 Between 2013 and 2014, unemployment rates fell increasingly for more disadvantaged areas. This data however does not tell us about the quality and stability of work available, particularly for those people living in more disadvantaged areas with already high unemployment rates. 33

Least deprived Most deprived Long-term claimants of job seekers allowance The rate of long-term (12 months+) claimants of Job Seekers Allowance fell from 9.9 per 1,000 population in 2013 to 7.1 in 2014. This follloowed a general rise in the JSA claimant rate over the period 2008 to 2013 (from 2.61 per 1,000 population to 9.9 respectively). The JSA claimant rate fell across all English regions between 2013 and 2014 (see Figure below). 34

At a local authority level, in 2014 the long-term JSA claimant rate was greater the higher the level of local deprivation. The JSA claimant count fell more, in more disadvantaged areas between 2013 and 2014. The data however do not tell us about the quality and stability of jobs available to those people moving off long-term unemployment benefits. Work-related ill health The positive downward trend for work-related illness seen between 2009/10 and 2011/12 for England reversed in 2013/14, when 4000 people per 100,000 (4% of workers) employed reported a work-related illness, up from 3,640 in 2011/12. 35

NB: Data unavailable for 2012/13. From 2015, annual data related to work-related ill-health is no longer published by HSE. From next year, we will report on 3-year averages. The summary table at the back of this report shows how self-reported work-related illness increased over the period 2011/12 2013/14 in each English region apart from London, the North East and the South East, where there was a respective 4.45%. 3.24% and 3.33% decrease in work-related illness, Yorkshire and the Humber, the East Midlands and the North East had comparatively higher proportions of workers reporting that work has caused or exacerbated an illness (4.86%, 4.85% and 4.48% respectively), compared to London (2.79%) and the North West (3.74%). Some areas also saw larger increases in work-related illness than others. In West Midlands, for example, over 45% more workers reported that work has made them unhealthy in 2013/14 compared to 2011/12. 36

The proportion of people with work-related ill health who had stress, depression or anxiety has generally become more similar over time to the proportion of people reporting musculoskeletal disorders. This pattern was most noticeable in 2011/12 and 2013/14, when only a respective 1% and 2.5% more people with work-related ill health reported MSK than stress, depression or anxiety. Between 2004/05 and 2010/11, the proportion of those reporting MSK was at least 9% higher than those reporting stress, depression or anxiety. 5. A minimum income for healthy living Households not reaching a minimum income standard The percentage of households in England without enough income to afford a minimum standard of living, as defined by the Joseph Rowntree Foundation based on what members of the public think is enough money to live on, has increased year on year since 2008. In 2012/13, just under a quarter (24.4%) of all households studied in England (which covers 2/3rds of household types in England) did not have enough income to reach an acceptable Minimum Income Standard MIS) 9. This is a 1.4 percentage point increase from 2011/12. The MIHL is used to set the real living wage the real living wage is higher than the National Living Wage, which is the new minimum wage rate set by Government. 37

Regional variation is also apparent. In London, where costs are higher, and in the North East, nearly 3 in 10 households (29.7% and 29.5% respectively) did not have enough income to afford a minimum acceptable standard of living. Those living in the East of England were least likely to have insufficient income, but this is still equivalent to nearly 1 in 5 (19.5%) households not having enough income. The figure below shows that, overall, since 2008/09 there has been an upward trend in the reporting of the proportion of households not having enough income for an acceptable standard of living in most English regions. In 2012/13, annual increases were recorded for the majority of English regions Although some areas saw a greater increase than others. Yorkshire and the Humber had the largest annual increase, with a further 4.7% of households not having enough, while London reported the smallest increase (0.3%). Only in the South West and the East Midlands were falls recorded in the proportion of households not having enough income from 2011/12 to 2012/13 (falls of 3% and 0.3%, respectively). This finding supports those reported in the Households Below Average Income data release that 10 11 shows how over half of all poverty is now found in working households Fuel poverty 10 Approximately 52% 11 DWP, 2013/14 HBAI. Table 3.5ts. 38

In 2013, 10.4% of English households were in fuel poverty, based on the low income, high cost methodology the same proportion reported in 2012. The percentage of households that experienced fuel poverty in 2013 varied across English regions. The West Midlands reported the highest proportion of households experiencing fuel poverty (13.9%), with the lowest proportion reported in the South East (8.1%). Between 2012 and 2013, five out of nine regions reported more households experiencing fuel poverty, with the rise in proportions ranging from a small 0.1% rise in the East of England to a 2.2% rise in the South West. Four regions reported falling proportions of households in fuel poverty during this period, ranging from 0.2% fewer households experiencing fuel poverty in Yorkshire and the Humber to 2.8% fewer households in the East Midlands. Overall, in 2013, there were more English households in fuel poverty the greater the level of deprivation. The graph below graph shows a strong positive linear association the greater the level of area deprivation, the larger the proportion of households in fuel poverty. 39

Percentage % change 6. Create and develop healthy and sustainable places and communities Access and use of green space for health and exercise Across all regions of England, more people are using outdoor space for exercise/health reasons, although percentages are still relatively low. The English average for 2013/14 was 17.1%, compared to 15.3% in 2012/13, an increase of 1.9 percentage points. However, the latest data shows that in 2013/14, the percentage of people using outdoor space was less the greater the level of local deprivation. Percentage of people using outdoor space for exercise/health reasons 25.0 3.5 20.0 15.0 3.0 2.5 2.0 10.0 5.0 1.5 1.0 0.5 0.0 East of England South East West Midlands England Yorkshire and the Humber North West North East London South West East Midlands 2012-13 15.5 15.0 16.2 15.3 16.5 15.0 16.0 10.5 21.2 14.6 2013-14 18.7 18.0 19.1 17.1 18.3 16.7 17.5 11.8 22.2 15.5 % change 3.2 3.0 2.8 1.8 1.8 1.7 1.5 1.3 0.9 0.9 2012-13 2013-14 % change 0.0 The proportions utilising outdoor space varied across the country however from a low of 11.8% of the population in London to almost double that in the South West (22.2%). In 2013/14, the East of England saw the greatest increase in the proportion of its population utilising outdoor space (a 3.2 percentage point increase). The smallest increase was recorded in the South West and East Midlands (0.9 percentage point increase). 40

In 2013/14, the percentage of people utilising outdoor space increasingly fell for more disadvantaged areas. The above graph shows a moderate negative association between area level of deprivation and utilisation of outdoor space, such that as area level of deprivation increased in 2013/14, the utilisation of outdoor space decreases. 41

Annex Indicators of area deprivation We use deprivation scores to look at whether or not there are inequalities in outcomes by level of deprivation. This year we are using updated deprivation indices (IMD2015) to examine variation across local authorities. This and the Index of Multiple Deprivation 2004 was used to compare life expectancy and disability-free life expectancy in 2009-2013 and 1999-2003, respectively. How has area deprivation been measured? Deprivation has been measured using the English indices of deprivation, produced by Department for Communities and Local Government (DCLG). The indices provide a measure of relative deprivation for all lower layer super output areas in England. It should be noted that not all residents of a deprived area will be deprived, and conversely, not all deprived people will live in deprived areas. The English Indices of Deprivation 2015 were published by the DCLG in September 2015. These are based on 37 separate indicators, organised across 7 distinct domains of deprivation which are combined, using appropriate weights, to calculate the Index of Multiple Deprivation 2015 (IMD 2015). The 7 primary domains of each index are shown in Table Al, with the relative weight of each domain shown in brackets. Although the domains and weights are the same in both versions of the IMD, there have been changes to some of the indicators which make up each domain. Table Constituent domains of Index of Multiple Deprivation 2015 and 2014 Index of Multiple Deprivation 2015 domains % Index of Multiple Deprivation 2004 % domains Income 2.5 Income deprivation 2.5 Employment 22.5 Employment deprivation 22.5 Education, Skills and Training 13.5 Education, Skills and Training 13.5 Health and Disability 13.5 Health and Disability 13.5 Crime 9.3 Crime 9.3 Barriers to Housing and Services 9.3 Barriers to Housing and Services 9.3 Living Environment 9.3 Living Environment 9.3 There have been changes in area level deprivation scores. Hull, Derby, Westminster, Middlesbrough and Nottingham are the areas that have seen the largest increase in deprivation. Waltham Forest, the Isles of Scilly, Greenwich, Hackney and Newham have seen the largest decreases in deprivation. Certainly for London boroughs it is worth noting that these changes may not be due to improvements in the living conditions of past residents, but rather an influx of a newer more affluent population. Caution therefore needs to be taken when looking at increases or reductions in results. Improvements in Hackney for example may have little to do with policies within the Borough but rather to do with the increased cost of housing. 42

Marmot Indicator Descriptions 2015 Annual indicators Healthy life expectancy at birth - males and females Source: Office for National Statistics The average number of years a male or female would expect to live in good health based on contemporary mortality rates and prevalence of self-reported good health. For a particular area and time period, it is an estimate of the average number of years a newborn would live in good general health if he or she experienced the age-specific mortality rates and prevalence of good health for that area and time period through their life. Life expectancy at birth - males and females Source: Office for National Statistics The average number of years a male or female would expect to live based on contemporary mortality rates. For a particular area and time period, it is an estimate of the average number of years a newborn would survive if he or she experienced the age-specific mortality rates for that area and time period through their life. Inequality in life expectancy at birth - males and females Source: Public Health England This indicator measures inequalities in life expectancy within English local authorities. For each local authority, life expectancy at birth is calculated for each local deprivation decile based on Lower Super Output Areas (LSOAs). The slope index of inequality (Sll) is then calculated based on these figures. The Sll is a measure of the social gradient in life expectancy, i.e. how much life expectancy varies with deprivation. It takes account of health inequalities across the whole range of deprivation within each local authority and summarises this in a single number. This represents the range in years of life expectancy across the social gradient from most to least deprived, based on a statistical analysis of the relationship between life expectancy and deprivation across all deprivation deciles. People reporting low life satisfaction Source: Office for National Statistics The percentage of respondents in the ONS Annual Population Survey scoring 0-4 to the question "Overall, how satisfied are you with your life nowadays". Responses are given on a scale of 0-10, where 0 is "not at all satisfied" and 10 is "completely satisfied". Good level of development at age 5 Source: Department for Education Children defined as having reached a good level of development at the end of the Early Years Foundation Stage (EYFS) as a percentage of all eligible children. Children are defined as having reached a good level of development at the end of reception if they achieve at least the expected level in the early learning goals in the prime areas of learning (personal, social and emotional development; physical development; and communication and language) and the early learning goals in the specific areas of mathematics and literacy. Good level of development at age 5 with free school meal status Source: Department for Education 43